Diploma Re-Order Form
1. While the original date of graduation will be shown, the graduate must agree to accept the
current diploma format concerning facsimile signatures, i.e., president, dean, etc.
2. The graduate must pay the appropriate diploma reprint fee of $35.00. Make check or money
order payable to TTUHSC.
3. Mail the completed form and reprint fee to the below address:
TTUHSC Office of the Registrar
3601 4th Street, MS 8310
Lubbock, Texas 79430-8310
4. We do not ship to Lubbock addresses, if you live in Lubbock you will be notifi ed when your
diploma is ready for pickup at our offi ce. If you have a PO Box, please provide the physical
Please print or type
SEND DIPLOMA TO: Name _________________________________________________
City ________________________ State ______ Zip __________
Home/Cell Phone Number ________________________________
E-mail Address _________________________________________
Name as it should appear on diploma: ______________________________________________
Date of Graduation: ______________________________________________________________
Degree Earned: __________________________________________________________________
Date of Birth:____________________________________________________________________
Last 4 of Social Security Number:___________________________________________________
I hereby certify that the above information is true and correct to the best of my knowledge.
Signature _______________________________________ Date __________________________
If you have any questions, please e-mail firstname.lastname@example.org.
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